子宮内膜症性疼痛に対する腹腔鏡下下腹神経切断術の1例

抄録

Objective: Two types of nerve transection have been used to treat endometriosis-related pain at the time of laparoscopic conservative procedure. However, laparoscopic uterosacral nerve ablation (LUNA) carries the risk of causing parasympathetic nerve damage and has been reported to provide no pain relief. Conversely, although laparoscopic presacral neurectomy(LPSN) has been proven to achieve additional pain relief, it has a high level of technical difficulty and is associated with issues such as hemorrhage, constipation, or urinary urgency. Theoretically, the ablation of the left and right hypogastric nerves just before the inferior hypogastric plexus, where the sympathetic and parasympathetic nerves branching from the superior hypogastric plexus meet, makes it possible to selectively and safely resect only the sympathetic nerves. However, this surgical technique has not been reported. In this paper, we report a case of laparoscopic hypogastric nerve transection (LHNT).

Case: A 45-year-old, nulliparous woman presented with menstrual pain, chronic pelvic pain, and an endometriotic cyst in her left ovary. Laparoscopic left adnexectomy, ablation of the endometriotic lesion on the peritoneum, and bilateral LHNT were performed. Postoperative evaluation after 6 months indicated that the pain had improved, and no episodes of urinary urgency or newly developed constipation were observed.

Conclusions: Hypogastric nerves could be laparoscopically identified. LHNT was a feasible procedure and did not cause any clear impairments to urinary or bowel function. The results suggest that LHNT in combination with the currently performed endometriotic lesion removal in patients for whom postoperative hormonal agent use is difficult could reduce endometriosis-associated pain.